Myocarditis. How do you manage it?

Myocarditis. How do you manage it?

Myocarditis is a rare heart condition that can be both subtle and fatal. In the majority of the patients, it goes unnoticed due to the absence of symptoms. In others, diagnosis occurs during autopsy. Among patients that have the disease, treatment is often supportive: to restore normal cardiac function.

Inflammation of the heart muscle (myocardium) constitutes myocarditis. We cannot delineate the cause in about half the patients; however, in the other half, viruses are mostly the culprits – Coxsackie B, HIV, hepatitis C, and adenovirus. A few other notable infectious causes are worth mentioning: Trypanosoma cruzi, tuberculosis, and diphtheria. Granulomatous inflammatory diseases such as giant cell myocarditis and sarcoidosis: eosinophilic myocarditis, polymyositis, dermatomyositis, systemic lupus erythematosus (SLE), and cocaine abuse are among the non-infectious causes of myocarditis. Myocarditis is neither hereditary nor contagious.

Myocarditis. How do you manage it?
Senior man with chest pain visiting his doctor.
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The rarity of myocarditis may partly be due to the difficulty in diagnosing it because patients often show no symptoms. We estimate that about 5% of patients with an acute viral illness have myocarditis. And we identify approximately 1.5 million patients globally. It is noteworthy that myocarditis occurs in the young population at increased frequency in comparison to adults. We haven’t noticed any sex or racial disparity in the disease occurrence.  

Among symptomatic patients, myocarditis may present with dyspnoea, lower limb swelling, chest pain, syncope, or palpitations – symptoms of heart failure. Clinical features specific to the disease do not exist. It often requires a high index of suspicion. Inflammation of the heart muscle may lead to abnormal rhythms (arrhythmias) and reduced cardiac function. Patients may also show clinical features pertinent to distinct causes like difficulty swallowing (dysphagia) in Chagas disease. Patients may present with myocarditis as part of other systemic diseases like SLE.

Upon examination, we may identify a few abnormalities within the heart. It will often prompt us to do electrocardiography (ECG), echocardiography, and laboratory tests. Chest radiography may delineate other causes of chest pain. In a few scenarios, we can biopsy the heart muscle to make a definitive diagnosis.

Related:

Atrial fibrillation. You might want to check your heart.

Once we confirm the diagnosis, treating chest pain and arrhythmias is the most crucial aspect. If a patient has heart failure, we treat it according to the regional or local guidelines; otherwise, treatment is entirely supportive.

We do not recommend using non-steroidal anti-inflammatory drugs in acute disease as they may interfere with cardiac muscle healing. For patients with systemic illnesses SLE, we involve the necessary specialists.

We recommend that any patient with myocarditis unresponsive to conventional therapy get a referral for advanced care. For the case of Uganda, such care is available at Uganda Heart Institute.

You must stop smoking and gradually refrain from taking alcohol after acute myocarditis.

Do not indulge in any physical exercise until your doctor clears you to do so.

Myocarditis may be a diagnosis of exclusion after we (doctors) do several tests, as noted above. It is so because several potentially sinister diseases can present with chest pain, palpitations, and syncope. They include acute coronary syndrome, coronary artery disease, coronary vasospasm, myocardial infarction (heart attack): pulmonary oedema, unstable angina, heart failure, pericarditis, and pericardial effusion.

Myocarditis may lead to permanent cardiac muscle damage, resulting in heart failure, arrhythmias, myocardial infarction, and sudden death due to cardiac arrest. So, it is prudent to seek medical attention if you experience any of the symptoms suggested above.

For more information, Mohammad Al-Akchar; John Kiel’s article was valuable to our research.

 

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